NeuroLogic - Making connections between obesity and migraine

Making connections between obesity and migraine

Date: April 30, 2012

Lee Peterlin uses DEXA scanners, most often used to measure bone density, to assess body fat content for her research.

photo by Keith Weller

For neurologist Lee Peterlin, migraines run in the family. She and her sister, Jackie, both suffer from migraine headaches that have been, at times, completely debilitating. That’s one reason why, several years ago, she started looking into why they and 30 million other Americans suffer from a neurological disorder whose cause, at least in part, remains a mystery despite the wealth of potential research subjects.

One thing researchers have long known, however, is that migraine sufferers—or migraineurs—are significantly more likely to be women of reproductive age. After puberty, body fat makes a significant jump in this population. Could body composition play a role in whether patients develop migraines?

Inspired by this kernel of knowledge, Peterlin searched the literature for previous research linking migraine with obesity. She turned up several promising studies, including research connecting obesity to a five times greater chance of developing chronic migraines and an increase in headaches in migraineurs who were sedentary, a potent risk factor for weight gain.

Besides seeing headache patients in the clinic, Peterlin says, she decided to focus her research on proteins that provide a link between obesity and migraine. Those include adiponectin and leptin, proteins secreted by adipose tissue that modulate immune and inflammatory components such as interleukin-6, tumor necrosis factor-alpha and nuclear factor kappa beta. Previous studies have shown that each of these compounds changes in concentration in those with either migraine or obesity.

“With several adipokines, and in particular with leptin and adiponectin,” Peterlin explains, “you have proteins that change several factors that we know are abnormal with both conditions. It’s a natural starting point in trying to understand what connects migraines and obesity.”

In a small pilot study, published in 2008, Peterlin and her colleagues evaluated adiponectin blood concentrations among episodic and chronic migraineurs and controls. They found significantly elevated levels in chronic migraineurs and a trend toward elevation in those with episodic migraine, suggesting that this fat tissue-associated protein may indeed play a role in migraines.

Peterlin has since focused her work on further examining the link between migraine and adipokines, as well as other pro-inflammatory compounds also linked with obesity. Knowing that these proteins are all associated with adipose tissue, she and her colleagues are also exploring whether the placement of fat—superficial or deep—might also play a role in migraines.

These investigations aren’t simply a matter of curiosity, Peterlin says. Understanding how obesity and migraine are linked could give physicians new tools to treat migraines, a problem that remains frustratingly intractable for some patients despite many different treatment options. Unlike some other conditions associated with migraine, such as stroke, she explains that obese patients can play an important role in their own treatment.

“Through diet, exercise and possibly even other interventions, such as bariatric surgery if indicated,” Peterlin says, “patients can actively participate in their own care to address obesity. Weight loss is a non-pharmacogenic ‘pill’ that’s been found to be medically sound and cost-effective for numerous other disorders. The headache community is showing that weight loss might play a helping role in migraines as well.”

Finding the connections between obesity and migraines may also help doctors better treat migraines using more traditional methods, like tricyclic antidepressants. Although they are a treatment of choice for many migraine sufferers, says Peterlin, some drugs in this class, such as nortriptyline and amitriptyline, can lead to weight gain—a problem for patients who are already overweight or obese. Another tricyclic antidepressant, protriptyline, has the opposite effect.

“If a patient is already in the weight danger zone,” Peterlin says, “that drug might be the better choice. Based on our research, taking body status into consideration should be an important factor in which drugs a physician prescribes.”

Peterlin points out that she and her colleagues have already made many important discoveries, but developing the full picture connecting obesity and migraine will take time.

“We know now that fat is more than just a storage depot,” she says. “Eventually, we’ll know just what part it plays in causing migraines.”